=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003187576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURENZO SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2012
-----------------------------------------------------
Last Update Date | 06/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 PITCHFORK TRL STE 705
-----------------------------------------------------
City | WILLOW PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76087-3257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-927-1925
-----------------------------------------------------
Fax | 888-667-1750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 133 SAM BASS RD
-----------------------------------------------------
City | WILLOW PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76087-7871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-475-8847
-----------------------------------------------------
Fax | 817-441-5850
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. DAVID CHARLES LAURENZO
-----------------------------------------------------
Credential | B.S., MBA
-----------------------------------------------------
Telephone | 817-475-8847
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------